Home Medizin Kalifornien drängt darauf, das Spektrum der Abtreibungsdienstleister zu erweitern

Kalifornien drängt darauf, das Spektrum der Abtreibungsdienstleister zu erweitern

von NFI Redaktion

California’s efforts to expand access to abortion care are allowing more types of providers to perform certain abortion procedures – potentially a blessing especially for patients in rural areas, but a cause for concern for physician groups who have long fought to expand the role of these abortions to non-physicians.

The recent step is a law that allows trained physician assistants, also known as „Physician Associates,“ to perform first-trimester abortions without a supervising physician present. The measure, passed last year and effective as of January 1, also allows PAs who have been disciplined or convicted in a state where the practice is restricted solely for performing an abortion to apply for a license in California.

Physician assistants are now on par with nurses and certified midwives trained in abortion care, who as of 2022 have the ability to perform abortions without a physician present. The need for more providers in abortion care is being driven by efforts in many states to exclude the right to abortion, after the Supreme Court lifted constitutional protection for the procedure in 2022. According to the Guttmacher Institute, a reproductive health research organization, 31 states have implemented abortion restrictions ranging from cutting federal funding for abortion coverage to outright bans.

With the new law, „there will be fewer obstacles and shorter wait times for this important service,“ said Jeremy Meis, elected President of the California Academy of Physician Associates. While it is unclear how many of the 16,000 California PAs are trained in performing abortions, studies show that PAs are more likely to practice in rural areas where access to abortions is limited. In more than 40% of California counties, there are no clinics that offer abortions.

Comparing data from the first six months of 2020 to the same period in 2023, the number of abortions increased from 77,030 to 92,600, a 20% increase, as the state became a haven for women seeking abortion. California has passed a series of laws on reproductive health to incorporate protective measures and improve access, and a dozen other states, including Oregon, Minnesota, and New York, have made similar efforts. According to the American Academy of Physician Associates, 17 states, including California, now allow PAs to perform first-trimester abortions.

There was little resistance to the new California law as it was supported by two physician groups. However, the American Medical Association, the most powerful physician lobby in the country, vigorously opposes what it calls „Scope Creep“ – changes allowing physicians like PAs to perform medical procedures independently of physicians.

“Our policy stance on expanding scopes of practice remains the same regardless of the procedure,” noted Kelly Jakubek, Media Relations Manager of the AMA. The AMA website highlights legislative victories in 2023, including the repeal of „laws permitting physician assistants to practice independently and without physician oversight,“ in states like Arizona and New York. The AMA has not issued a formal statement on California legislation. Their local branch, the California Medical Association, took a neutral position on the legislation.

In anticipation of the new law, a physician assistant at Planned Parenthood Pasadena & San Gabriel Valley began learning how to perform aspiration abortions – a procedure also known as dilation and curettage, in which a pregnancy is ended by gentle suction. The PA, who asked for anonymity due to safety concerns, said, given abortion restrictions in place nationwide, „I just think it’s very important to provide patients with a convenient, safe, and very effective option for pregnancy termination.“

She is now one of six physicians and midwives at her clinic who can offer aspiration abortions. To acquire this skill, she participated in 50 procedures and learned how to administer medications that reduce pain and anxiety. Such conscious sedation is commonly used in first-trimester abortions. Now, like any other physician in advanced practice who has acquired skills in performing abortions, she can train her colleagues – another feature of the new law.

The duration of training and the number of procedures to acquire competency vary depending on a practitioner’s prior experience.

„It promotes this interprofessional education and collaboration, which is really important if we want to improve access to essential services,“ said Jessica Dieseldorff, Senior Program Manager for Abortion Services at Planned Parenthood Mar Monte in Santa Cruz.

In December, California allocated $18 million as part of the Reproductive Health Care Access Initiative to accelerate training of abortion and reproductive medicine providers, including PAs.

Dieseldorff, a nurse who educates other advanced clinicians in abortion care, said rural communities in particular will benefit as many rely exclusively on physician assistants and other allied clinicians.

Reflecting on her career, she said a lot has changed since she became a nurse 25 years ago. At that time, she worked only as support staff for doctors performing abortions.

„When I started, there were no medication abortions in this country,“ she said, referring to the practice of using two commonly prescribed medications to induce abortions. „It was gratifying that I could evolve and become a healthcare provider myself, offering patients non-stigmatizing, compassionate, and safe care and now, at this stage of my career, can educate others to do the same.“

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